The National Drug Strategy a guide for local partnerships 2008

by Sara McGrail and David MacKintosh What Is... the London Drug Policy Forum (LDPF)?

LDPF is a unique body, funded by the City of London, which works with all who have an interest in reducing the problems associated with drug use. In particular we assist, support and advise policy makers on drug issues affecting the capital, and work with the London boroughs, Drug Action Teams, CDRPs law enforcement agencies, health organisations, drug agencies and government departments to promote good practice relating to education and prevention, commissioning, community safety and improving services for drug users. The LDPF has also undertaken work with ACPO and the EU around synthetic drugs and patterns of use, and has produced materials around drug driving, workplace policies and drug use in the night-time economy which have been quoted as examples of international best practice. ‘Drugs: Protecting Families and Communities’ focuses on building on the successes of the last strategy (and hopefully learning lessons from the stuff that ‘proved more of a challenge’!)

As this strategy has a much greater focus on local decision making and planning than its predecessor, we were hoping to do something a bit different with how we presented stuff this time.

In each of the previous guides, we’ve begun our section of organisations and people with a description of the central government departments and worked our way down through regional government until we got to the Drug Action Team (DAT) and the local community.

This time round we were hoping to start out at the level of the community and then explore the organisations and departments in regional and central government who are there to help us to meet local need.

Sadly its still too tricky to visualise the Drug Strategy as ground-level up. However, the signs are there that this is what the Government intends to achieve, and so we’re keeping our fingers crossed that next time round we can turn the world on its head.

This then is the third – and still top-down - edition of The National Drug Strategy a guide for local partnerships. Whether you are a DAT Coordinator, a Joint Commissioning Manager (JCM), a Community Safety Manager, or in related areas, we hope you will find this guide makes your job easier to do and takes away some of the headaches.

One of the headaches we had in pulling this together was working out what to call you all. On the assumption that a DAT by any other name would smell as sweet, we have elected to refer to the range of local partnerships that work specifically around drugs - DATs, DAATs, DARTs – as DATs. When we make reference to Local Strategic Partnerships (LSPs) we refer to the most senior local partnership – the one that takes responsibility with the local authority for the Local Area Agreement (LAA).

Later this year we will also be publishing a shortened version of this guide (Everything You Ever Wanted To Know About Local Drug Policy But Were Afraid To Ask) to help members of the community and people who aren’t drug specialists gain a greater understanding of the challenges and opportunities effective drug strategy can bring. We hope these two publications together will help you strengthen commitment across all your local partner agencies to tackling the local challenges you face around drugs in your area. The Two Minute Guide... (take a deep breath)

In 1985 the Conservative government produced the first national drug strategy – Tackling Drug Misuse, followed in 1995 by Tackling Drugs Together. In 1998 the incoming Labour government produced theirs – Tackling Drugs to Build a Better Britain and then updated it in 2002. In 2008, the government produced a new strategy – Drugs - Protecting Communities and Families.

The strategy contains the vision for the national response to drugs, but the devolved administrations are responsible for developing and delivering drug strategies which meet their particular needs. The rest of this guide refers only to England.

The Home Office has overall ownership of the drug strategy and is responsible for co-ordinating delivery of its constituent strands, which are owned by a number of different departments, including the Ministry of Justice, the Department of Health and the Department for Children, Schools and Families.

Like all areas of policy, drugs is subject to Public Service Agreements (PSAs) – central targets that the Treasury uses to see if government money is being spent effectively. At a local level these public service agreements are monitored by Local Authorities through the use of a set of basic indicators – a kind of handbook of what needs to be accounted for locally in terms of benefits to individuals and the wider community. Government monitors how well local areas are delivering to these indicators and targets through the Regional Government Offices and in the case of drugs treatment through a special health authority called the National Treatment Agency.

Local agencies work in partnership to make sure that the drug strategy is being effectively implemented locally. Some areas do this through a specific group called a Drug Action Team (DAT). Others include the work alongside crime and community safety in the work of the Crime and Disorder Reduction Partnerships (CDRPs). Through these arrangements, local partnerships:

- Work with the community to identify the key local issues around drug misuse
- Prepare local action plans and strategies to tackle drugs
- Commission treatment and other interventions to help people who have problems with drugs, experience and cause less harm
- Tackle issues around drug supply and crime and disorder related to drug use
- Provide a range of interventions through schools and children’s services that help children and young people deal with drug issues

(You can breathe out now) The National Drug Strategy Protecting Families and Communities

The strategy covers four main areas

- Protecting communities through robust enforcement to tackle drug supply, drug-related crime and anti-social behaviour
- Preventing harm to children, young people and families affected by drug misuse
- Delivering new approaches to drug treatment and social re-integration
- Public information campaigns, communications and community engagement

It comes in two parts. There’s the main document with the details of the four themes and the direction of work over the next 10 years. Then there’s the Action Plan. This contains details of the specific actions Government is committed to in terms of illegal drugs over the next three years. It tells you what the outcome of the work will be and which government departments will be responsible for it. You’d be strongly advised to read it. It can be found at www.drugs.gov.uk/publication-search/drug-strategy/drug-action-plan-2008-2011

What is... all this ‘reduction’ about?

There are three key areas of responsibility for every local drugs partnership. These are:

1. **Harm reduction** – reducing the harm people do to themselves, their families and the community through their use of illegal drugs and alcohol. The key harms this type of work seeks to reduce are: physical (health) harms to the individual and the community e.g. by the provision of needle exchange, community and social harms associated with substance misuse and by the provision of maintenance prescribing.

2. **Demand reduction** – reducing the level of demand for illegal drugs. This refers to initiatives aimed at: preventing people starting to misuse drugs e.g. drug education in schools; programmes of diversionary activity supporting people who are misusing drugs to stop e.g. residential and community detox, rehabilitation, structured day services.

3. **Supply reduction** – reducing the availability of illegal drugs. This will largely focus on criminal justice agencies’ work to: prevent drugs being traded or distributed and prevent drugs being produced in, or entering, the UK. Underpinning Ideas Many of the core themes of the last strategies appear again in the current one. The acceptance of the critical role of treatment, supply side interventions and drug education in meeting the needs of communities and individuals and the underpinning philosophies of Harm, Demand and Supply Reduction are all in evidence.

One of the most challenging aspects of this strategy are the new concepts, themes and ideas the government wants to explore over the next three years. Personalisation, new styles of commissioning, mainstreaming and localism all play their part in bringing DATs to the top of the agenda.

The shift to a more individualised (and hopefully in time personalised) approach is really rooted less in the discovery of a human heart beating there at the centre of government, than in the need to achieve better community level and individual outcomes with the money that is being invested in the drug strategy and particularly in treatment.

What is... Personalisation, Self Directed Support and Individualisation?

| Personalisation or Self Directed Support are terms that relate to the reworking of social care interventions to ensure that the service user is in control of what services they receive, how they receive them and who provides them. Sometimes people confuse this idea with Individual Budgets and Individualisation, but they are not the same thing at all. Individual budgets give us a different way of distributing resources that can be an important tool for self directed support. Individualisation simply means tailoring services to individual need – requiring an element of self direction but not necessarily putting the service user in control. | |---| | Because of the way Personalisation has developed in other fields – like mental health – the focus is on the social care or reintegrative support that service users receive. Some of the work being done however is now looking more closely at how Personalisation or Individualisation may work in healthcare. In drug treatment there is no clear definition of how Personalisation or Individualisation might work. However as we write in the summer of 2008 this is a hot topic and lots of people are having a poke about in it (including the Cabinet Office and the RSA). If you want to know more have a look at the work of InControl www.in-control.org.uk | Although there is still a big clinical treatment component, the focus of the work has shifted. Reintegration, housing, training, employment and education are high priorities. Treatment is seen as a route back into the community, a way of ensuring that people who have experienced problems can access re-integrative support from mainstream services (and stop causing trouble). It’s been accepted that housing and training and employment bring benefits and support recovery from early on in someone’s treatment journey and shouldn’t just be stuck on the end like a lollypop at the end of a visit to the dentist.

### What is... Recovery?

Many people in the drugs field and the NTA have begun to use the concept of recovery to describe the optimum outcome of treatment and interventions for drug users. (This is a broader term than ‘recovery’ when used in the USA.) Recovery – both Abstinent and Medication Supported Recovery (aka maintenance or substitute prescribing) is a term that’s going to play a big part in service development over the next few years. Recovery Capital is the physical, psychological and social resources available to an individual to help them move towards recovery.

Happening alongside this new focus on individual outcomes, is another revolution which has begun outside the drugs field and the world of DATs but is coming our way. The drive for localism and mainstreaming grew out of concerns that British public service provision was siloed, bureaucratic, overly centralized and that this made services less cost effective in meeting the needs of communities than it could be.

### What is... Mainstreaming?

Mainstreaming has two related but slightly separate meanings – a bit like two sides of the same coin.

First of all, Mainstreaming is the systematic consideration of the particular needs of a community in relation to drug use in all areas of policy and social provision rather than simply looking at drugs in isolation and delivering services in a silo.

What this means in practice is that mainstream services like primary care, housing services, education and regular social care would be expected to take account of drug use and the needs of people and communities affected by drug use in all their work. Equality of access and opportunity is the goal for communities and individuals. Mainstreaming is a process that aims to achieve that goal.

The other meaning of Mainstreaming is the removal of the ringfence from around a pot of funding to enable services to be delivered more effectively from within mainstream services utilising all resources available. Localism suggests that more decisions about service provision and strategy should be taken locally – not just by local government and local partnerships but by communities and individuals. The speed with which this will impact on drug strategy is not clear at the moment.

A Policy Framework – How Does This All Fit Together? The policy framework for the strategy includes the three year Action Plan, the Public Service Agreements (PSAs) and the 198 Indicators within the local government framework. When we look at the three year Action Plan, what we can see is that there’s a really challenging agenda ahead. Covering all the areas of the Strategy, the action plan will take us up to the next Spending Review and the next set of Public Service Agreements.

What is... the Spending Review?/What is... a Public Service Agreement (PSA)? The spending review is carried out by the Treasury and sets firm and fixed three-year departmental expenditure limits and, through public service agreements (PSAs), defines the key improvements that the public can expect from these resources. The next spending review is due to take place in 2010 but will be dependent on the timing of the next election. PSAs are an agreement between the Treasury and the Departments who receive public funding. They are there to enable better performance management of public services. A PSA has an overall aim, a set of objectives and a set of targets. Published alongside this information is a Technical Note which explains the methodology for measuring the targets. What are... the PSAs for drugs?

The new PSAs for Drugs are 14 and 25. These PSAs have specific measures about Drugs and Alcohol

**PSA 14 – Increase the Number of Young People on the Path to Success**

The drug specific indicator that fits under this PSA is

NI 115 – Substance Misuse by Young People. This Indicator measures the total number of respondents to the Ofsted Tellus Survey who report frequent use of drugs and/or alcohol.

**PSA 25 – Reduce the Harm Caused by Alcohol and Drugs**

The Indicators that sit under this PSA are

NI 20 – Assault with injury crime rate

This Indicator is largely focussed on alcohol related assault.

NI 38 – Class A Offending Rate

This Indicator will focus on an identified cohort of Class A drug misusers and will track the rate of their offences over the year. This has been deferred until 2009-10

NI 39 – Alcohol related hospital admission rates

NI 40 – Drug Users in Effective Treatment

The number of drug users recorded as being in effective treatment with the proxy for ‘effective’ being 90 days in treatment. Don’t imagine you’re out of the woods if your local partnership hasn’t chosen this as stretch target. In return for the Pooled Treatment Budget you’re signed up to being monitored by the NTA on this one I’m afraid.

NI 41– Perceptions of drunk or rowdy behaviour as a problem - collected via community consultation and once again focussed almost entirely on alcohol use.

NI 42 – Perceptions of drug use or drug dealing as a problem – The percentage collected via community consultation

In addition a number of other PSAs are linked to the strategy. These include

**PSA 8 – Maximise Employment Opportunity for all**

**PSA 13 – Improve children and young people’s safety**

**PSA 23 – Make Communities Safer**

**PSA 24 – Deliver a more effective, transparent and responsive CJS for victims and the public (contains measures relating to DIP)**

**PSA 21 – Build more cohesive, empowered and active communities**

**PSA 16 – Increase the proportion of socially excluded adults in settled accommodation and employment, education and training (at the moment only defines ex offenders, people with learning disabilities, care leavers and adults in contact with secondary mental health services as the vulnerable people for whom reintegration should be measured)**

**PSA 18 – Promote better health and well being for all** The Drugs Public Service Agreements Alcohol is now included in the PSAs – in fact some of the measures within them are only or mainly relevant to alcohol.

PSAs also now work differently to the way they used to. The direct link up between the PSA and the work of the local partnership is much more explicit and much stronger than ever before.

Under the PSA’s is a framework of indicators which include the Local Government Indicators agreed between the government and the Local Government Association. The Local Government Indicators were negotiated between the DCLG and the LGA in the summer of 2007. They are directly linked and referenced to the PSAs – creating that loop between central and local government that’s critical for accountability within a localist structure.

Woven into this are two other sets of indicators. There are Vital Signs, the DoH performance framework for health and the Assessments of Policing and Community Safety (APACS) indicators. For convenience we have covered these in more detail on our section on Local Indicators, Vital Signs, APACS and Drugs - Making it Work Locally. What this means is that they get their LAA money (known as the Area Based Grant) plus the additional money they bring to this work and agree to spend the bulk of it on making sure they do better at the targets they’ve chosen (more of this later).

So who’s going to implement all this? Well you are of course. You’re not completely on your own though – there’s any number of people you’re going to need to work with, and for, (and – unfortunately, sometimes, around!) if you’re going to get to grips with your local drugs problem. But lets start out at the top… National Government Departments and their Responsibilities

The **Home Office** (HO) takes the lead in driving forward the Drugs Strategy and meeting the PSAs, but responsibility for implementation is shared between several departments, including the Home Office, Department of Health and the Department for Children, Schools and Families. Home Office specific responsibilities include the Drug Interventions Programme (DIP) and enforcement and availability.

The **Department of Health** (DH) is responsible for the effective treatment target inside PSA 25. It manages this partly via the National Treatment Agency and partly with Primary Care Trusts and Strategic Health Authorities through ‘Vital Signs’. Drug misuse also features as one of the public health priorities for the Department.

In 2007 it published an action plan, Reducing Drug Related Death, which detailed activities including a public health campaign, enhanced monitoring of blood borne viruses and injecting use and peer led initiatives to promote safer practice.

The **Ministry of Justice** (MoJ) and DH share responsibility for one of the fastest expanding areas of the new drug strategy – Prisons. The 2008 strategy places a great deal of emphasis (and the only new resources) on improving drug treatment and support for recovery and reintegration in prisons. There is obviously significant overlap between the role of the Home Office and the MoJ around DIP and offender management. Some rationalisation of the central infrastructure looking at prolific and priority offenders and drug related offenders has taken place within the Home Office. How, or if, this may transfer to the MoJ or NOMs in due course is not yet clear.

**What is... The Drug Interventions Programme (DIP)?**

The Drug Interventions Programme (DIP), is a separately funded programme of work delivering to the criminal justice performance measure of the PSA. Its main focus is in providing enhanced case management and rapid, seamless access to treatment, support and aftercare for all drug using offenders. Areas that have higher crime rates are DIP Intensive Areas – this means they got extra money and could deploy measures within ‘Tough Choices’ such as test on arrest and required assessment.

From 2008 while DIP is being maintained, any areas seeking intensive DIP status will need to fund these developments themselves. The Department for Communities and Local Government (CLG) is responsible for ensuring that the new substance use PSA targets are reflected in the planning and performance management of Local Strategic Partnerships.

CLG is also responsible for making sure that Local Area Agreements (LAAs) do ‘what they say on the tin’ and genuinely enhance service delivery through effective partnership, revitalising local democracy and enabling people to have a real say.

The Department for Children, Schools and Families (DCSF) is responsible for ensuring that substance use is recognised in the holistic support of young people by Children’s Trusts – including responsibility for the provision of adequate drugs education, diversionary activity, harm reduction interventions and treatment interventions (in partnership with the NTA). The approach to young people’s work identified in the 2008 strategy builds on this into what is a fully mainstreamed approach.

Other Government Departments Within the new strategy there is quite a bit of room for other parts of Whitehall to get involved. Both the Foreign and Commonwealth Office (FCO) and the Department for International Development (DFID) have a role in representing the UK’s interests in international drugs work. The Treasury as ever will be monitoring how much it all costs and if its any good. The Department for Work and Pensions (DWP) have a role in helping deliver the reintegration agenda given their imperative to reduce the numbers on benefits. Enforcement and Availability – National Bodies

The Association of Chief Police Officers (ACPO) (www.acpo.police.uk) is an independent body that represent the most senior officers within the police service. It works with central government and the Association of Police Authorities. ACPO leads and co-ordinates the development of the police service in England, Wales and Northern Ireland. It has had an important role in drug policy development and produced the national guidance on the policing of cannabis.

The Serious Organised Crime Agency (SOCA) takes a UK wide approach to improving co-ordination and bringing pressure to bear on organised crime. SOCA identifies drug trafficking in heroin and cocaine – particularly crack cocaine as the greatest single threat to the UK in terms of the scale of serious organised criminal involvement, the illegal proceeds secured and the overall harm caused. SOCA is also a key agency in improving the seizure of criminal assets – for which the new strategy set an ambitious target of £250m per year by 2009/10. SOCA’s stated priorities include working with partners within the UK and internationally to reduce harm.

HM Revenue and Customs (HMRC) enforces border security and as such has an important role in seeking to stop drugs coming into the UK. Most of the investigation functions from HM Customs and Excise have transferred to SOCA, but Revenue and Customs remain a key agency in dealing with drug dealing. National Specialist Agencies and Departments

The National Treatment Agency for Substance Misuse (NTA) was established in 2000 as a Special Health Authority to ensure delivery to the treatment strand of the Drug Strategy. It is sponsored by the Department of Health and they manage its performance via a service level agreement.

The current functions of the NTA include:

- performance management of the treatment planning process
- effective performance management of DIP
- development of effective policy to support treatment (clinical standards, creation of evidence base)
- inspection of treatment services (with the Healthcare Commission for the next year)
- monitoring of the effectiveness of treatment
- monitoring of specialist treatment for young people.

While the NTA's head office is based in London, they have teams in each of the English regions – these are co-located with the Government Office Drugs Teams in the Government Offices for the Regions. There will be an imperative over the life of this strategy for NTA regional teams to work very closely with the regional SHAs.

The Crime and Drug Strategy Unit (CDSU) is the section of the Home Office responsible for drugs – not just in terms of treatment, but also availability, organised crime and young people (jointly with NTA/DCSF). CDSD currently:

- co-ordinates activity across the drug strategy;
- is responsible for the overall monitoring and delivery of the Drug Strategy;
- has lead responsibility for legislation and for enforcement activity;
- delivers cross-cutting work and other projects.

The National Offender Management Service (NOMS) is part of the MoJ. NOMS replaced Probation as the body who manage punishment, rehabilitation and supervision of convicted offender in the community. NOMS structure differs from that of the old Probation service in that it describes its role as being a commissioner rather than a provider of services. The Probation Service will continue to provide services and manage offenders, however its work will be increasingly opened up to competitive tender through commissioning by the NOMS Regional Offender Managers (NOMROMs). The Youth Justice Board (YJB) oversees the youth justice system in England and Wales – managing the performance of the YOTs. Their role is to prevent offending and reoffending by children and young people under the age of 18, and to ensure that custody for them is safe, secure, and addresses the causes of their offending behaviour.

The Healthcare Commission is the health watchdog for England. Its job is to promote improvements in the quality of healthcare and public health. They are responsible for assessing and reporting on the performance of both NHS and independent healthcare organisations, to ensure that they are providing a high standard of care. In partnership with the NTA they undertake a programme of inspection and service improvement.

The Commission for Social Care Improvement is the government inspectorate for social care services (this includes many drug rehabilitation centres). CSCI regulate the private, voluntary and state social care sector. Sometime between late 2008 and spring 2009 the Healthcare Commission and the Commission for Social Care Inspection (along with the Mental Health Act Commission) will be merging to form one new cross-cutting inspectorate. The roles of the inspectorates have been increasing in importance as a result of the need for regulation of the new markets emerging from the wider health and social care reform agenda.

What’s this about... Health and Social Care Reform?

The UK health and social care system has been undergoing radical reform over the past few years. The aim of this has been to improve outcomes for patients and consumers by putting them at the centre of the system.

The key mechanism for this in healthcare has been anticipated as being the establishment of a plural market (one with a number of providers) for healthcare where the consumer has a choice and the provider is paid for the numbers of individuals that they see and the outcomes they achieve. In social care, the focus has also been on the individual service user as an empowered purchaser at the centre of a system of care with multiple providers (see Personalisation).

The greatest impact this has had so far in the drugs field has been in establishing the principle of the plural market – with most DATs having gone through multiple procurement processes. However as yet the position of the commissioner and the state as the arbiter of quality and appropriateness has not been superseded by the principle of individual choice. It remains to be seen how any reductions in funding will impact on this style of market management. Regional Agencies

The Government Offices for the Regions (GORs) are intended to bring implementation and decision-making closer to ‘the people’.

There are 9 Government Offices in England – South East (GOSE), London (GOL), South West (GOSW), East (GOE), East Midlands (GOEM), West Midlands (GOWM), Northwest (GONW), Yorkshire and Humberside (GOYH), and North East (GONE). Each Regional Government Office is organised slightly differently. However, the structure of the teams dealing with drugs and crime are broadly similar across the board.

Each Government Office has a Home Office Regional Deputy Director who is responsible for working with local partnerships - CDRPs, Youth Offending Teams (YOTs), LSPs, DATs - to develop and implement effective crime and drug reduction strategies. Within the unit managed by the Regional Crime Director are the Crime Reduction Advisers and the Drugs Advisers (also known as the Government Office Drugs Team).

Alongside, inside, or surrounding these advisers are the NTA regional team featuring anything from 1 to 9 Deputy Regional Managers, the Regional Administrator, some data/information officers and the Regional Manager.

The Government Offices have a particular responsibility for negotiating and performance managing the local performance targets in the Local Area Agreements (LAAs).

**Directors of Children and Learners.** A recent development in Government Offices is the consolidation of Young People and education agendas in the new roles of Directors of Children and Learners accountable to the DCFS.

The **NOMS Regional Offices** (NOMROs) and **Regional Offender Managers** (NOMROMs) are the individuals charged with commissioning the services for punishment, rehabilitation and supervision in the community and in prisons. They have been charged with producing Reducing Reoffending Plans for each region – however this area of work is currently subject to an ongoing consultation (due to report mid 2008). NOMROs map to the Government Offices for the Regions.

The **Youth Justice Board** (YJB) Regional Teams map onto the nine government office areas. The YJB regional Teams monitor the performance of YOTs through the YOT Performance Framework (and the National Standards for Youth Justice) and help them improve where necessary. **Strategic Health Authorities** (SHAs) are the regional presence of the Department of Health charged with the fiscal and strategic management of health provision in each of the regions.

The 10 SHAs oversee all the NHS bodies in their areas (except Foundation Trusts) including Hospital Trusts, Ambulance Services Trusts, Care Trusts, Mental Health Trusts but the relationship which is arguably their most critical is that with the Primary Care Trusts (PCT).

Strategic Health Authorities manage the Pooled Treatment Budget insofar as they receive the money from Department of Health and distribute it according to the agreed local allocations to the PCT. In real terms, their involvement with drug treatment or strategy has been minimal – however there are signs that this is improving with SHAs ‘upping their game’ across a range of strategic health issues including drugs.

**Public Health Observatories** (PHOs) are tasked with supporting PCTs, local government and local strategic partnerships with information and analysis to enable effective local health strategies to be put in place.

There are nine PHOs in England, which map to the Government Office areas. In most areas PHOs hold the contract for production and analysis of National Drug Treatment Monitoring System (NDTMS) data – the exception to this is London. Police Authorities

As the Police Service operates at county/regional and municipal levels so all areas have a local police authority. Police Authorities are comprised of members drawn from local authorities, magistrates, plus independent members.

Police Authorities have an important role in setting policy for their respective police services, in holding the police to account for their activities (scrutiny) and in consulting with the public.

Their role and interest around drug issues varies across the country, but they are an important partner in establishing local policies and practice – so it might be worth talking to your local members have a look on your local police force or police authority website to find out who they are.

Local Criminal Justice Board

LCJBs were first set up in 2003. Broadly speaking they cover county areas – there are 38 altogether in England. The Court Service, the Crown Prosecution Service, the Police, the Prison Service, the National Probation Service, National Offender Management Service and YOTs are all members of LCJBs. Each LCJB has a ‘liaison’ judge, with whom they work closely. Their key interest in the effective operation of the Criminal Justice System. Thus far their impact on drug issues has been marginal, however, should DIP shift further towards the Ministry of Justice, potentially their involvement could become greater. Non Governmental National Bodies

**Alcohol Concern** ([www.alcoholconcern.org.uk](http://www.alcoholconcern.org.uk)) provide information and encourage debate on the wide range of public policy issues affected by alcohol; including public health, housing, children and families, crime and licensing. They support specialist and non-specialist service providers helping to tackle alcohol problems at a local level, whilst also working to influence national alcohol policy.

**Adfam** ([www.adfam.org.uk](http://www.adfam.org.uk)) are the national charity representing and working with families affected by substance misuse. They provide direct services and also seek to influence policy particularly as it affects children and parents.

**The Alliance** ([www.m-alliance.org.uk](http://www.m-alliance.org.uk)) is a user led organisation which provides advocacy, training and helpline services to those currently in drug treatment, those who have accessed drug treatment in the past and those who may access drug treatment in the future. (weblinks)

**European Association for the Treatment of Addiction** ([www.eata.org.uk](http://www.eata.org.uk)) is an umbrella organisation for the independent drug and alcohol treatment and aftercare sector. EATA is a membership organisation representing 500 services provided by its members in the UK and Internationally.

**Narcotics Anonymous** ([www.ukna.org](http://www.ukna.org)) is a national network of self help groups or fellowships who believe that the cornerstones of recovery is in the therapeutic value of addicts working with each other to achieve recovery through local groups. In meetings members regularly share their personal experiences with each other, providing support and advice.

**DrugScope** ([www.drugscope.org.uk](http://www.drugscope.org.uk)) is a UK charity focussing on substance use. They provide drug information, promote effective responses to drug taking, undertake research at local, national and international levels, advise on policy-making, encourage debate and represent a broad group of organisations in the drugs field.

**United Kingdom Drug Policy Commission** ([www.ukdpc.org.uk](http://www.ukdpc.org.uk)) is an independant body providing academic analysis of UK drug policy. Their aim is to improve political, media and public understanding of drug policy issues and the options for an effective (evidence-led) response to the problems caused by illegal drugs. Local Partnerships Working Around Drugs

Crime and Disorder Reduction Partnerships (CDRPs) Since the Police Reform Act 2002 (amending The Crime and Disorder Act 1998) all local authorities are statutorily bound to have a partnership, The Crime and Disorder Reduction Partnership (CDRP) which is responsible for:

• carrying out a review of the level and patterns of crime and disorder and drug misuse and • formulating and implementing a strategy for the reduction of crime and disorder and for combating drug misuse and • submitting an annual report on implementation of their strategies

The Police and Justice Act 2006 set off a process of reform of CDRPs, more firmly placing them within Local Strategic Partnerships (LSP). Critically, Section 17 of the Crime and Disorder Act was strengthened giving LSPs a responsibility for mainstreaming drugs, crime and antisocial behaviour in all of their work.

However onerous this set of new planning requirements might seem, its actually very similar to the structure that was in place in 2001/2 – and may provide you with some real opportunities to get a truly linked up local drugs strategy. You might also be able to use this to help your CDRP engage more effectively with their public health and NHS members.

A new National Standards Framework for local partnerships was published in late 2007. This identified key activities for which the CDRPs would have statutory responsibility focused on drugs, crime and anti social behaviour. Through this framework the LSPs and central government are able to assess the performance and capacity of their CDRP. The framework is built around what are called the ‘Hallmarks of Effective Partnership’. Each Hallmark is made up of statutory duties and good practice guidance.

The six key ways identified for CDRPs to work essentially boils down to good management, a good understanding of the local situation, community engagement and accountability. A new requirement is that county wide authorities must now also have a strategy group and an assessment and plan – as well as this being delivered at district level.

Depersonalised information sharing is a statutory duty of all partners and a protocol to the effect must be agreed.

There is a requirement for an annual consultation with the community and in addition to this CDRPs are required to have at least one ‘Face the People’ style meeting per year in which senior people from all responsible authorities are present.

However, partnership performance will likely be centrally assessed through the Comprehensive Area Assessment (CAA) and against PSA 23 which reinforces the importance of local community perceptions of crime and disorder. The new Home Office performance framework Assessment of Policing and Community Safety (APACS) is also likely to play a significant role in enabling both the public and government to understand more about the effectiveness of CDRPS and the constituent agencies. We have covered this in more detail in our section on Local Indicators, Vital Signs, APACS and Drugs – Making it Work Locally.

**DATs and Other Local Drug Partnerships**

In some areas, drugs issues are dealt with entirely through the Crime and Disorder Partnership (CDRP). In other areas, the Drug Action Team (DAT) leads on drug issues. Often the DAT is subordinate to the CDRP, but in some areas the DAT is a freestanding body. In some areas where alcohol is dealt with by the DAT as well as illicit drug use, the Drug Action Team is known as the Drug and Alcohol Action Team (DAAT).

DATs have representatives from most of the responsible authorities (LA, PCT, Police etc) with the addition often of HM Revenue & Customs and Local Drug Treatment providers. In non-unitary authorities the DAT is often located at county level – and will now be able to link more effectively with the new county level CDRP strategy groups. Over the past couple of years it's become more apparent that when people talk about ‘The DAT’ they mean the people who work in jobs that have the word DAT in the name. This is actually wrong. The DAT is the partnership group, the meeting of the great and hopefully good, who link up drug strategy in an area. The Co-ordinator and the Joint Commissioning Manager (JCM) are not the DAT – they work for it.

The responsible local partnership (whether it’s a DAT or a CDRP) will deal with issues right across the Drug Strategy. This will include:

**Supply side interventions** – how close you get to integrating these locally will depend on how good you’ve been at getting your local police to play ball – and for that matter how your local police are set up to deal with drug issues. It’ll help if you’ve got a strong CDRP – but its notoriously difficult to get the right level of representation at the DAT and JCG from the people in blue. Seeking to develop the right contacts here can pay major dividends.

**Treatment** – Inevitably because of the current emphasis on demand reduction strategies, and because of the overall balance of drugs spending, a large part of any local partnership’s workload is currently around the commissioning of drug treatment against the Pooled Treatment Budget (PTB) - a cross departmental central government funding stream for drug treatment which replaced separate drugs budgets for local agencies like Police, Local Authority and Probation.

Few CDRPs or even DATs have the capacity themselves for commissioning and contracting and so it is generally done on their behalf by the local Primary Care Trust (PCT).

Often the PCT themselves will subcontract the contracting part of the deal down to one of the acute or provider trusts. When this is the case you need to ensure that performance is still actively managed – making a strong link between the cash and the delivery is important. This is where the potential is strongest for drug service delivery to get lost in aggregated mainstream contracts – particularly with Mental Health and Foundation Trusts.

The DAT’s work includes commissioning and managing not just treatment in the community but if you’ve got a prison or a YOI on your patch, treatment inside too. And this goes double if your local nick is part of the Integrated Drug Treatment System (IDTS). In addition to what we have come to think of as core treatment, the latest reports on levels of drug related deaths and blood born viruses mean that looking at basic harm reduction services should be of increasing importance nationally and locally – inside and out. What’s all this about… treatment in prisons?

In 2005 the responsibility for healthcare inside prisons passed from the Home Office to the local PCT. At around the same time, many people working in DIP observed that drug interventions and particularly treatment simply weren’t a reality in many if not most prisons. The IDTS was set up with the express intention of ensuring that an increased range of treatment options integrated within one system, meeting the standards of care outside prisons be established for all prisoners experiencing problems with substance use. A very important aspect of IDTS is the way it has sought to link up treatment inside and outside prison.

The Cross Cutting Agenda – when DATs were first set up a key part of their work was seen as joining local responses together. To an extent the emphasis on criminal justice interventions and structured treatment has seen some of this work put on the back burner. With the recognition that dealing with the impact of problematic drug use is about more than this comes the need for DATs to make sure that all the local players are:

- round the table
- contributing (practically and financially)
- accountable for their delivery

See page 42 for some ideas on how you might want to ‘lever in’ in resources and support. This needs to translate into real opportunities to improve things for people and communities affected by problematic drug use. So for housing services it might mean supporting people to retain tenancies rather than eviction or for education providing additional support to families or schools.

Children, Young People and Families – This is about ensuring your Children and Young People’s Strategic Partnership or Children’s Trust is taking proper account of drug issues in its strategy, policy, planning and service delivery (i.e. making sure that ‘mainstreamed’ hasn’t come to mean ‘disappeared leaving this here pool of money…’)

Community Liaison – With the emphasis back on community consultation and engagement a big part of a DAT’s work over the next few years is likely to involve working with your local communities and community groups. The new strategy places an increased emphasis on working with the community and the families of people experiencing problems with drugs. You might find it useful to link up with family and community support agencies in your area to make sure that they are ‘mainstreaming’ drugs in what they do and are aware of the services you are commissioning and developing.

Please see section on Community Consultation on page 44 What is… a Good DAT?

The CDRP Hallmarks for effective practice go some way towards defining how a good local partnership working to tackle drugs issues should look. However these only really go as far as the crime and disorder side of the DATs work – and there’s a lot more that needs to go on.

Here are some tips from us about how a good DAT might look:

A Good DAT...

• has effective, informed enthusiastic senior level representation from the range of agencies that deal with drug issues locally. The members of a good DAT don’t just dump everything on the DAT co-ordinator – they get involved.

• is about more than crime and treatment – its role is to co-ordinate treatment, availability/supply side interventions, community, young peoples interventions and local strategy in areas such as housing, regeneration, education and environment to ensure the best joined up responses to drug problems for your area

• understands the local drug problem – from the circumstances of its drug markets to the level of blood borne viruses

• recognises it cannot just wait for the government to tell it what to do but is never caught out when the NTA calls them to their quarterly review

• has a strong joint commissioning group (JCG) that involves all relevant agencies in decision making about provision.

• delegates power to commission services to its Joint Commissioning Group but it performance manages that work – and keeps an eye on service provision itself

• has an effective information function – so it can keep up to date on progress

• plans and implements a realistic programme of activities and a range of services which addresses local needs while responding to the demands of central government and regulators

• ensures the DAT links into other local strategic partnerships – particularly the LSP and community forums and consultation groups.

• communicates with its stakeholders, the community and Government

A Good DAT meeting…

• does not go on for 6 hours, leaving everybody looking like they’ve been 10 rounds with the Beast of Bodmin, not understanding a word that’s been said since the coffee break.

• has a clear brief meaningful agenda that everyone can take part in

• uses its membership to take a 360 degree view of issues

• is held regularly – and at least quarterly

• makes decisions! Most Local Drugs Partnerships nominate one of their constituent bodies as the budget holder for the PTB. They will also establish a Joint Commissioning Group (with budget holding representatives of all the agencies), supported by a Joint Commissioning Manager who will manage the process on their behalf. This post holder (and it could be you!) will usually be employed within an integrated commissioning team housed in either the Local Authority or the PCT.

**Joint Commissioning Groups**

In most areas a Joint Commissioning group takes delegated responsibility from the senior officers attending the CDRP/DAT to commission drug treatment on their behalf.

Treatment should be commissioned in response to local need and in line with Models of Care (2002 + 2005).

Treatment commissioning is like the commissioning of any kind of service. You’re trying to find out what’s needed, and how you can get it cheapest at the best quality and you want to make sure that they keep providing it well and that it keeps doing what you need it to do.

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**What is... ‘Models of Care’ (MoC)?**

Models of Care and its 2005 update is an ‘evidence-based’ strategy setting out national standards of care that drug users can expect to receive from treatment providers.

The framework of Models of Care comprises definitions of four tiers of treatment, integrated care pathways through them, care planning and co-ordination and monitoring.

The four tiers of treatment identified in Models of Care are:

- **Tier 1**: Non substance-misuse specific services requiring interface with drug and alcohol treatment
- **Tier 2**: Open access drug and alcohol treatment services
- **Tier 3**: Structured community-based drug treatment services
- **Tier 4**: Residential services for drug and alcohol misusers If it stops working well, you need to take a look at what’s happening and maybe if it doesn’t fit your needs anymore, go out and buy something different. Sometimes though, it’s better to do a bit of work to get it to fit your needs rather than simply chuck it out and start again.

That’s what’s called the commissioning cycle. It’s not rocket science but it does require you to have a good needs assessment – and an ongoing evolutionary, developing understanding of what’s going on in your patch both in the services you commission and in the world of the people who use them. You also need to be up to date on best practice in the types of services you commission and the needs they meet. People were thrilled when the penny farthing came out, but no one’s going to ride to work on one today…

Bluffers guide to the commissioning cycle

- What’s needed?
- Is it working?
- How will we do it?
- What are we going to buy?
- What’s going on?
- Who are we going to buy from and how? Youth Offending Teams (YOTs)

YOTs were established by the 1998 Criminal and Disorder Act. Prior to this, most Youth Justice issues were dealt with by departments with Local Authorities – usually located in Social Services. The YOT is a multi agency team (made up of probation staff, social services staff, healthcare workers, education workers, drug and alcohol services, police and housing officers) charged with tackling all aspects of youth crime and disorder including prevention of offending and re-offending, supervision of offenders and resettlement of young offenders leaving custody if they are under the age of 16.

The YOT identifies the needs of each young offender through a formal assessment. The YOT worker responsible will work with the young person and their parents to identify the specific issues that make the young person offend as well as measuring the risk they pose to others. The YOT team will identify suitable programmes to address the needs of the young person to help them stop offending.

YOTs are key partners in Children’s Trusts. YOTs are inspected on a 5 year rolling programme by a Joint Inspectorate lead by HMI Probation and including Healthcare Commission, HM Inspectorate of Constabulary, HM Inspectorate of Prisons, HM Inspectorate of Probation, Office for Standards in Education. YOTs are performance managed by the Youth Justice Board (YJB). Drugs are a big issue for many YOTs and your DAT’s partnership with your local YOT should be ongoing and a priority. Local Police Structures

Organisation of the police on a local or borough level varies enormously across England. Check out with the community liaison team at your local nick what structure applies in your area. Most areas no longer have a drug squad – with drugs being seen as part of mainstream policing. Different police forces prioritise different levels of drug crime – according to local circumstances.

All police areas are now committed to working in partnership – however in reality what this means is different from area to area. Remember drugs is not always a local policing priority however the Police are often very keen to work supportively around treatment, harm reduction and co-ordinated intervention with you and your DAT. Local police involvement is essential to any partnership. The right working relationships will help you influence and keep you involved in what happens at borough/basic command unit level (BCU).

What is… a BCU?

Usefully, it depends on where you are. In some areas a BCU is a Basic Command Unit – this is the usual model for shires (but not always). A Basic Command Unit is often led by a Chief Superintendent reporting to a Chief Constable at County or Regional Force level. Most have considerable autonomy to set their own priorities with the boundaries of the Local Policing Plan.

In other areas – mainly metropolitan ones – a BCU is a Borough Command Unit. These are co-terminus with local authority boundaries, and are generally led by a Senior Officer usually a Chief Superintendent or Commander reporting to an even more Senior Officer - usually an Assistant Chief Constable or Deputy Assistant Commissioner.

Both BCUs and – er - BCUs produce an annual policing plan setting out the priorities for the area. These are submitted to the Force command at regional/county level. Safer Neighbourhood Teams (SNT) are an initiative that aims to effectively root local policing within communities. They do provide an opportunity for the public to engage with the local police/community safety officers and there is also scope for communities to help set SNTs priorities, however partnerships will need to ensure that this is based on an accurate and informed understanding of what local problems are.

However well linked you think you are to local policing strategy if your work is not having an impact on neighbourhood policing you’re not making the most of your time or resources. So make sure you both support and challenge the Safer Neighbourhood Teams in your area. Providing training is one way of doing this.

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**What is... this about different levels of drug crime?**

In line with the National Intelligence Model (NIM), police forces categorise and prioritise drug crime at three levels.

- **Level 1** is defined as local crime being dealt within a Basic Command Unit (e.g. street level dealing).
- **Level 2** is crime affecting more than one Basic Command Unit (e.g. cross borough dealing of 1-3 kilos – also referred to as the middle market).
- **Level 3** is serious and organised crime operating on a national or international level (e.g. importation of drugs or moving multi kilos quantities within the country).

Your local force may have a priority to tackle level 1 crime (in terms of its impact on communities) or may be working in partnership with its neighbouring commands or national agencies to deal with serious and organised crime as a priority. You can influence how these priorities are set – but you need to do it with your partners in the Police Authority and CDRP. Local Drug Specific Plans

Needs Assessment is a critical part of the local planning process – and there is guidance available from the NTA about this in terms of treatment and DIP. It is also a big part of the new statutory duties of the CDRP. You may want to combine your treatment needs assessment with your strategic local crime and disorder substance misuse assessment – and if you can, an overview of local community needs (eg around youthwork provision, employment and housing initiatives) into one overall DAT needs assessment.

The Treatment Plan is the annual set of documents you are expected to complete in order to receive the Pooled Treatment Budget. It comes in four sections each of which relate to a function of the commissioning process:

(i) The Strategic Summary – this is where you summarise all the information available around substance use – specifically with regard to treatment - in your area. This very important section of the Treatment Plan enables you to contextualise your commissioning decisions in the light of local need and central imperatives. Within this section you will also be required to set your ambitions for numbers in treatment etc for the year ahead. To deliver a strong section 1 you need a good needs assessment.

(ii) The Self-Assessment Checklist – this is where you have an opportunity to assess your area’s progress against an NTA checklist. This is a really useful exercise if you are new to either your local area, or drug policy. You may wish to fill this in with your DAT or Joint Commissioning Group.

(iii) The Planning Grids – this is where you will detail all your commissioning activity for the year ahead and identify the cost and timescale for each activity.

(iv) The Funding Bit – this is where you detail all the resources – so that’s real money and then the other stuff like secondments, bits on aggregated contracts etc – that support your treatment plan.

What is it about... Ambition Setting?

Ambition Setting is a process you need to go through in order to establish what percentage improvement you will achieve locally in terms of numbers in effective treatment. Although this is an important part of your treatment planning, the picture focus for this exercise is not in fact the NTA though your Deputy Regional Manager will be keenly interested and will show this through ongoing support. This is in fact the target that will sit in your PCT’s, Local Development Plan (LDP) responding to both Vital Signs and Local Government Indicators (NI 40). How these ambitions can be incentivised within the new formula for the Pooled Treatment Budget (see page 33) is yet to be seen. The Treatment Planning Template is released by the NTA in October of each year. A draft is required usually by the first week in January. This draft will go to a regional panel (including senior managers and service users) that will assess it. If it’s believed by the panel that your plan is good and accurate and represents a responsible use of the budget they will approve it at this stage. Otherwise early in March a series of recommended changes will be laid out and you will be required to amend your plan by the start of the new financial year in April.

**Children and Young People Substance Misuse Plans** Local authorities must develop Children and Young People Plans. DATs/CDRPs are expected to jointly agree local priorities and targets around substance use to include in the unitary children’s plan and where appropriate the YOT plan. DATs and partnerships are also expected to produce a specific and separate Young Persons Treatment Plan (backed up by a needs assessment) for the NTA.

**IDTS Plan** Areas with a prison that is part of IDTS are also required to work with the prison and the local partners – specifically the PCT - to produce the IDTS plan.

**Healthcare Commission Inspections** The Healthcare Commission has been working with the NTA on an 3 year programme of inspections – with two themes a year – to which DATs and treatment providers have been required to report. DATs that perform poorly in these inspections may be required to prepare, submit and implement an improvement plan looking at areas of poor performance. This programme is due to end in 2009 – when the HCC become part of a new big ‘super inspectorate’. It remains to be seen how inspection of drug treatment will continue after this – however signs are that the merging of HCC with the CSCI may bring about a more mainstreamed approach to drug service inspection and regulation. Watch this space. Performance management of the treatment elements of the National Strategy are undertaken by the NTA through their regional teams and with reference to NDTMS information (which you are also required to submit to get your paws on the Pooled Treatment Budget). Partnerships have been required to submit returns to the NTA which have identified partnership performance against a range of real output targets and proxy outcome indicators such as retention in treatment and waiting times. However the reliance on proxy outcome indicators will be replaced as TOPS beds in.

The Drug Intervention Programme (DIP) is directly performance managed by the DIP team within the Home Office – but much of the groundwork is undertaken by the NTA. DIP client work is recorded on the Drugs Intervention Record (DIR) which is completed by all the agencies who work with an individual. These records are collated to produce monthly ‘Dashboard Reports’ for every DIP area and service detailing the number of individuals who are assessed, present for treatment and successfully complete treatment. These reports are available via DIRWEB.

What is... NDTMS?

The National Drug Treatment Monitoring System is the system by which data is collected from drug treatment providers about every individual in treatment on a monthly basis. Compliance with making returns has previously been patchy, however the majority of providers and DAT areas now use electronic data transfer (EDT) which is ensuring that the system can provide much more up to date and accurate information.

What is... TOPs?

The Treatment Outcomes Profile (TOPs) is a national system applied to each individual coming into treatment via the care management and assessment process which records the key outcomes of their engagement in treatment across 4 key domains:

- Drug and alcohol use
- Physical and psychological health
- Social functioning
- Offending and criminal involvement

The gathering of this information throughout an individual’s treatment journey should enable a clear national picture of the impact of treatment to emerge. This will in turn enable better understanding of the value for money of the investment by government in this area of public policy and aid the development of individualisation (and hopefully personalisation) of services. They could also help us identify how mainstreaming is working in an area.

TOPs data will be collected via routine returns to NDTMS. What About the Money? Drug Budgets

The Pooled Treatment Budget (PTB) – is a central government funding stream for drug treatment that replaced separate drugs budgets for local agencies like Police, Local Authority and Probation. In 2008 the Pooled Treatment budget was announced as a non-inflation proofed standstill budget with a new allocation formula.

What is... the new formula for the PTB?

There are 4 components to the new formula for PTB allocations.

**Activity** – this is the number of individuals ‘in effective treatment’ which means retained for 12 weeks or more or discharged successfully before 12 weeks. This applies to 75% of the allocation.

**Case Mix** – a step closer to individualisation this part of the formula rests on the calculation that it costs twice as much to provide treatment to a crack or heroin user as it does to provide treatment to someone who uses other drugs. Put simply, this means that you now get twice as much money for people who use crack and heroin as you do for people who use benzo’s, speed or cannabis.

**Caseload Complexity** – 25% of the allocation is determined by factors reflecting the complexity of the local treatment population - using the York Formula as a proxy for caseload complexity. The York Formula is a way of distributing healthcare funding that is based on health inequalities and deprivation (i.e. if the area is more deprived and has higher rates of certain key health indicators, they will receive more money).

**Area Cost Differential** – This is actually the Market Forces Factor (MFF) something developed in healthcare to measure the real difference in cost of providing one type of service in different areas.

In principle although allocations have been published for the years 08/09, 09/10 and 10/11 it has been said that areas who improve their performance will receive more money, though it is unclear where the additional funding will come from if the initial settlement by the Department of Health remains the same. **Area Based Grant (ABG)** is the big pot of funding into which funding streams such as the Safer and Stronger Communities Fund have been mainstreamed. Local Authorities are free to use this funding as they see fit. So DATs need to be making their case heard to get a share.

**Drugs Intervention Programme (DIP) Funding** – All DAT areas receive DIP funding which comes directly from the Home Office to the Local Authority – this is to cover the costs of providing the DIP programme to the required level in your area. As we have already said, there will be no central funding for additional intensive DIP areas. Critical Mainstream Local Partnerships And Plans

Local Strategic Partnerships (LSPs) are multi-agency bodies which cover local authority areas and bring together at a local level the different parts of the public, private, voluntary and community sectors.

LSPs provide a single local co-ordination framework within which joined up planning for service delivery can take place. LSPs can tackle deep-seated, multi-faceted problems that require a range of responses from different bodies working together.

Don’t expect that drugs and drug related issues will be a large part of your LSP’s discussions. Drugs and even Community Safety are a small part of a very wide agenda that encompasses everything from public transport to school dinners to ambulance services.

One of the main jobs of the LSP is the production and co-ordination of the Sustainable Community Strategy (often called the Community Plan). Its critical that if you are the person who is responsible for drugs strategy, service development and commissioning in your area that you engage with your LSP. If you are not based in the Local Authority find out who the lead for the LSP is in your agency and speak to them about it.

What is the … Sustainable Community Strategy?

Sustainable Communities Strategies are designed to promote or improve the economic, social and environmental well-being of local residents through sustainable development.

They set a long term (up to twenty years) vision for the area, which aims to improve the quality of life of local people and identify local priorities for service delivery.

They include an action plan with shorter-term (1, 2 and 3 years) priorities and activities that will contribute to the achievement of the vision.

The responsibility for developing the Sustainable Community Strategy lies with the Local Authority, but other members of the LSP must work with them to prepare and implement it.

Because it can seem like every man and his dog (Spot) is a member of the LSP nowadays, meetings can be long, tiring and unproductive affairs. LSPs have an awful lot of work to do, so a lot of LSP business will be conducted outside of the main meeting in a sub group. LSPs all have different structures – but the majority will have a number of subgroups covering issues such as

- Children and young people
- Education and skills
- Employment and enterprise
- Housing
- Health
- Transport
- Area based regeneration initiatives
- Community Safety

You need to find out what the subgroup is that is charged with tackling drugs in your area. It may be that the CDRP itself is a subgroup of the LSP – in which case you need to make sure that drugs is well up the CDRP agenda. It may even be that the DAT is a subgroup of the LSP (particularly in some of the shire counties).

It’s likely however that no one group will be responsible for the whole of drugs in your area. The Community Safety Group will be responsible for drugs and crime, but the health group would probably have responsibility for blood born viruses. Young People’s drug issues will almost certainly be dealt with by a young people’s sub group. You might need to work with the housing group to get an issue around housing dealt with.

Your job with the is to get each of the sub groups to recognize and accept their role in tackling local drug problems. You will need to talk to chairs of the sub groups. You will need to show them WHY drugs is a priority issue but also help them understand they can do something about it. One way you can do this is by demonstrating the impact that drug use has on their area of concern. You might want to make sure that whatever needs assessment you undertake locally clearly identifies not just the drug issues of the area in terms of treatment and offending, but also housing, anti-social behaviour, education and healthcare.

**What is... the Concordat?**

| The concordat was negotiated between the Local Government Association (LGA) and the Department for Communities and Local Government (CLG) and sets out a new relationship between central government and local government. It’s based on the belief that where ever possible or practical services are best determined and delivered at a local level. The 198 Local Government Indicators are the framework developed to monitor key areas of activity. | |---| | The most important thing about the Concordat is the explicit acceptance on the part of government that the 198 Local Government Indicators will be the sole performance management framework for local government and its partnerships. |

**The Local Area Agreement (LAA)** is the agreement made between local partners and Central Government that makes a reality of the Sustainable Community Strategy. An LAA is a three year agreement that sets out the priorities, targets and outcomes for a local area agreed between Central Government, represented by the Government Office (GO), and a Local Strategic Partnership (LSP). LSPs agree to deliver to a series of Mandatory Outcomes (including targets around Crime and Disorder, Anti-Social Behaviour and Drug Use) and in return they are given the freedom to achieve the agreed outcomes in a way that they define as meeting local needs and circumstances. The targets of the LAA are taken from the Local Government Performance Framework published by the Department for Communities and Local Government. However they also link with (and in many case are coterminous with) the indicators within Vital Signs and APACS.

It works like this. Data is collected about all the indicators – all 198 of them that is. The LAA is made up of stretch targets against these indicators – areas and issues that your local partnership know they need to improve (or areas that government tells them they need to improve!). 17 of these targets are mandatory for all local authorities – and they have mainly to do with education and young people. The local partnership picks up to a further 35 indicators and identifies stretch targets against them.

The Area Based Grant (ABG) and other resources are then spread across these areas and with the additional resources in place and a joined up local agenda in play, the partnership moves towards improvement. Local Indicators, Vital Signs, APACS and Drugs – Making it work locally

Just as the diagram above suggests the local indicators for drugs sit at the convergence of three performance management frameworks. The dominant framework is the Local Government Performance Management Framework (aka the ‘198 Local Indicators’ or the ‘Local Indicators Set’ – or that ‘darn’ list). The drugs indicator that sits within Vital Signs is in this framework, as are the APACS indicators.

So the indicators themselves...

| Number | Measure | Drugs? | Alcohol? | Vital Signs? | APACS? | 198? | |------------|-------------------------------------------------------------------------|--------|----------|--------------|--------|------| | NI 20 (PSA25) | Assault with injury crime rate | ✔ | ✔ | ✔ | ✔ | ✔ | | NI 38 (PSA) | Drug-related (Class A) offending rate | ✔ | ✔ | ✔ | ✔ | ✔ | | NI 39 (PSA25) | Alcohol related hospital admission rates | ✔ | ✔ | ✔ | ✔ | ✔ | | NI 40 (PSA25) | Drug Users in Effective Treatment (retained for 12 weeks or discharged successfully before this) | ✔ | ✔ | ✔ | ✔ | ✔ | | NI 41 (PSA25) | Perceptions of drunk or rowdy behaviour as a problem | ✔ | ✔ | ✔ | ✔ | ✔ | | NI 42 (PSA25) | Perceptions of drug use or drug dealing as a problem | ✔ | ✔ | ✔ | ✔ | ✔ |

It is not your job to collect all the information for these indicators, however given that you need to monitor them, budget for them, plan services around them and understand them, it might as well be. Remember as well the NTA are going to be monitoring you separately – outside this framework – to make sure that you keep hold of your Pooled Treatment Budget and spend it on the things that central government wants you to spend it on. The status of DIP funding is uncertain at the moment, but its fairly likely to follow a similar path – with the NTA monitoring your activity against the output and process measures defined in the DIP conditions of grant. A number of PSAs are not directly related to drugs measures but reflect issues that are at the very heart of the new strategy – like reintegration, housing, employment, training, community involvement, neighbourhood policing and regeneration.

The lack of measures in the 198 Indicators, APACS or Vital Signs relating to the impact of drugs in these areas is going to make it difficult for you to deliver these elements of the strategy locally. Essentially it could be a tricky for you to monitor progress in these areas in the short term unless you make a case locally for collecting the data yourself – maybe by adapting some of the measures under these PSAs in the local government performance management framework (or the 198 Indicators as its usually known).

What is... Vital Signs?

Vital Signs is the NHS framework for measuring and managing national and local priorities. NHS Organisations use the Vital Signs to develop local operational plans that deliver against national and local priorities. As in other areas of the public sector, central performance management is being limited to a small number of core indicators (tier one national priorities). The drug target from Vital Signs is the same as that in PSA 25 – the numbers of drug users in effective treatment.

What is... APACS?

The Assessments of Policing and Community Safety (APACS) framework was introduced in 2008 and applies to police forces in England and Wales.

It covers key services delivered by the police working on their own or in partnership by establishing indicators of performance eg: ‘Assault with injury’ crimes per 1,000 population (which links to National Indicator 20 within the Local Government Indicator set.) APACS is linked with other local developments, principally the PSAs, The Local Government National Indicator Set (where APACS indicators are embedded) and the Audit Commission’s work on the Comprehensive Area Assessment process.

The APACS indicator set is unfortunately not available in its final form at the time of going to press so specific information is not available. However indications are that it will be in place in the ‘not too distant future’. For example, say your partnership decided what you needed to do locally was really make sure that drug users coming out of treatment were getting access to employment and training. There’s a measure under PSA 16 that will probably work –

**NI 149 Adults in contact with secondary mental health services in employment, training or education.**

You might want to look at the number of adults in employment, training or education who are, or have been, in contact with drug treatment services.

What you need to do is make a case for why this stuff is important. You might want to say “its in the drug strategy and informal signals are that these measures could be in place in the future”. You might even be able to get informal agreement to add in to your next LAA as a voluntary measure.

You might want to talk about the evidence base for reintegration and recovery and how it adds value to treatment spend. However, if you can just get agreement to monitor this – either through your LAA or even just through your DAT, you’ll have made a good start – and your work will benefit by being in an area of effort that your LSP recognises as critical.

Getting money out of the LAA is a tricky business. LSPs may be inclined to spend the bulk of their ABG on meeting the stretch targets. It may be that if your LAA is particularly enlightened or if they have picked the drug treatment or drug related crime indicators as part of their 35, that they will understand that spending on treatment without spending on reintegration, housing and employment is empty investment.

Another way you might work this is by suggesting that the Comprehensive Area Assessment is going to be looking at a much broader range of local activities – including how the partners meet need. Some work to demonstrate the need for reintegration, housing and employment may go a long way.

If your area is going to be in receipt of the Working Neighbourhoods Fund, (replacement for NRF), this might be another way you could make stuff happen.

You need to remember the onus is on local partnerships to do this– no one is going to tell you to do it. Adapting, building, chivvying…

One of the other things you might want to do is look at what indicators your LSP has already chosen and how you could adapt and measure alongside them a range of voluntary local drugs or drug and alcohol targets. If you can agree a set of these as a DAT you may find you’re ahead of the game next time around – and at least you’ll have a baseline. The table below gives you some examples of how you might measure drugs issues alongside these indicators. Please note this list is not exhaustive! Don’t stifle you creativity with this lot – read your LAA and see what you can fit in that reflects local need round drugs. You may find the following a useful crib sheet for meetings with local heads within your Local Authority or PCT. | Indicator | Ideas for DAT Monitoring | |-----------|--------------------------| | **NI 109** Number of Sure Start Children Centres | DCSF DSO(*) Number of SureStart centres providing interventions or signposting around drugs or working with drug misusing parents – helps with your implementation of Hidden Harm | | **NI 111** First time entrants to the Youth Justice System aged 10 – 17 | PSA 14 First time entrants who have been screened for drug misuse problems – this should be 100% | | **NI 118** Take up of formal childcare by low income working families | DWP DSO Take up of childcare by families where drug misuse is a problem – this is a specific target of the new Action Plan | | **NI 119** Self-reported measure of people’s overall health and wellbeing | DH DSO Self reported measure of the health and well being of people in treatment - you could use TOPS for this | | **NI 128** User reported measure of respect and dignity in their treatment | DH DSO* Users reported measure of respect and dignity in drugs treatment - manners do matter | | **NI 140** Fair treatment by local services | PSA 15 Fair treatment by local drug services – maybe a measure that could be looked at in partnership with local advocacy services? | | **NI 152** Working age people on out of work benefits | PSA 8 People in or recently discharged from drug treatment on benefits – fits with the new focus on employment | | **NI 156** Number of households living in Temporary Accommodation | PSA 20 Number of people in or recently discharged from treatment living in temporary accommodation | | **NI 17** Perceptions of anti-social behaviour | PSA 23 Responses to concerns over ASB linked, or stated to be linked, to drug use. |

(\*) DSO’s are Departmental Strategic Objectives and are owned by the Departments indicated

- deferred until 2009-10 | Indicator | Ideas for DAT Monitoring | |-----------|--------------------------| | **NI 18** Adult re-offending rates for those under probation supervision | PSA 23 | DRR reoffending rate anyone? | | **NI 21** Dealing with local concerns about anti-social behaviour and crime by the local council and police | PSA 23 | Dealing with local concerns about drug related ASB and crime by the DAT or other local body | | **NI 28** Knife crime rate | HO DSO | Knife crime where the individual is in possession of or tests positive for a class A substance | | **NI 29** Gun crime rate | PSA 23 | Gun crime where the individual is in possession of or tests positive for a class A substance | | **NI 32** Repeat incidents of domestic violence | PSA 23\* | Repeat incidents of domestic violence where the individual is in possession of or tests positive for a class A substance | | **NI 50** Emotional health of children | PSA 12 | Emotional health of the children of drug misusing parents – important for Hidden harm | | **NI 58** Emotional and behavioural health of children in care | DCSF DSO | Drug use by children in care – a difficult issue in many areas | | **NI 65** Children becoming the subject of a Child Protection Plan for a second or subsequent time | DCSF DSO | Children of drug misusing parents becoming the subject of a Child Protection Plan for a second or subsequent time | | **NI 68** Referrals to children’s social care going on to initial assessment | DCSF DSO | Referrals to children’s social care going on to initial assessment from drug treatment agencies | | **NI 88** Number of Extended Schools | DCSF DSO | Number of extended schools providing drug education/interventions for families | Local priorities need to be set not just by a few people in the town hall sitting down with Government and saying “this is how it is” but be backed up by genuine community consultation and solid needs assessment. In this way we make sure that the activities undertaken in a local area are what people living there need and want. This is the real meaning of localism and is at the centre of the new drug strategy.

What’s all this about ….Community Consultation?

One of the key ways in which LSPs are changing local policy making and service provision is in the requirement placed on them by legislation to consult with their local community to develop and update the community strategies. This consultation may take place differently in each area but it is likely to include

- Public meetings (which anyone can come along to) in community venues including ‘Face the People’ meetings
- Setting up a forum of local people and businesses who can be regularly polled for their views at meetings, by phone or through questionnaires
- Conducting a general household survey
- Inviting organisations and individuals to comment on specific proposals
- Talking directly to groups affected by specific areas of policy

Essentially consultation is as real as the people undertaking it want it to be – but if it’s conducted properly it can really help you understand what’s going on in your local community. Consultation should also help the LSP prioritise their work. You may find people in your area think drugs is a priority even if your LSP doesn’t.

There are some cautions around this however. For example, one of the indicators in the local set is ‘lowered local perceptions of drug use or dealing as a problem’ as a measure of success in dealing with drugs. This might not always be the case. If you set up a new treatment service in an area local people will almost certainly initially at least have a heightened perception of drug use as a problem, so look carefully at the responses you get to consultation and the targets that you grow from it.

This is also where all that data you’ve been collecting can really come in useful, if there’s anything that influences people more than a flourish of semi relevant views it’s a flourish of relevant data. Remember, the information you collect for government may feel like a pain at times, but its your information for you to use to help make the local response stronger and better. So use it, and augment it and think about what it means.

Drugs is a difficult issue for people to deal with in consultations – and it could be useful if you can get involved in the group designing and working on consultation in your area. Drug users and their families are likely to find it difficult to come forward and speak openly about their experiences, so its worth exploring innovative ways in which you can reflect their views and experiences in the work you do. This might not just mean asking people who are in treatment what they think about treatment, but also about housing and education and policing as well. Children’s Trusts From 2008 every local area has had a Children’s Trust including partners from all statutory agencies whose job is to bring together all services for children and young people with focus on improving outcomes for all children and young people. Lots of Children’s Trusts have different structures, but all of them will have:

- A joint needs assessment for young people
- Shared decisions on priorities
- Pooled resources
- Joint commissioning

Children and Young People’s Plans (CYPPs) are a statutory requirement. The CYPP is a single, strategic, overarching plan for all services that affect children and young people in the area, provided by the local authority and all partners. The Local Authority prepares the CYPP jointly with its partners – not just the regular statutory partners like the YOT and the PCT but all organisations working with young people such as colleges, culture, sport and play and recreation organisations, registered social landlords and the voluntary and community sector.

Children’s Trusts are committed to delivering against the five key outcomes defined in ‘Every Child Matters’ – The Government Strategy for Children and Young People published in 2003. This groundbreaking green paper – which became The Children’s Act 2004 established the principle that it is the responsibility of all agencies who work with children and young people to ensure that they have the support to be able to:

- Be healthy
- Stay safe
- Enjoy and achieve
- Make a positive contribution
- Achieve economic well-being

Performance against the five key outcomes for children and young people is assessed through the Annual Performance Assessment (APA) and the Joint Area Review (JAR).

APA focuses on how much council’s services have improved outcomes for children and young people. The APA uses data (with a framework of key indicators) the Children and Young People’s Plan, any reviews of this plan and other supporting information. It’s a desk based exercise and doesn’t involve site visits. The Joint Area Review (JAR) is a three-year programme running until December 2008 and all 150 local authority areas will have one joint area review during this time. It looks at local progress towards the 5 key outcomes but uses a different and more focused methodology including onsite investigative visits, direct consultation with young people, front line workers, parents, elected members and others. Both the APA and the JAR will be incorporated into the Comprehensive Area Assessment from 2009.

Young people’s substance use strategy should be governed by the local Children’s Trust and will need to be fully integrated into local young people’s services. Every Child Matters – the Government Strategy for Children’s Services - has already had a significant impact on the way services dealing with drug and alcohol issues for children and young people are delivered. Instead of setting up specialist services, the focus is on making sure mainstream services and interventions deal with drugs as part of the range of issues facing young people. Every Child Matters: Change for Children – Young People and Drugs gives guidance on co-operation and joint planning.

What is … The Comprehensive Area Assessment (CAA)?

The CAA is currently being reformed and guidance has yet to be issued about how the framework will be built. However, the 2007-08 Corporate Assessment uses Key Lines of Enquiry (KLOE). These are likely to remain in some form. The 2008 KLOE currently in use are:

The corporate assessment uses Key Lines of Enquiry (KLOE) to provide a framework to gather and assess evidence about how the council is working.

The KLOEs are:

Theme 1 **Ambition for the community** Theme 2 **Prioritisation** Theme 3 **Capacity** Theme 4 **Performance management** Theme 5 **Achievement**

Achievement is assessed by exploring how the Local Authority is delivering local priorities and outcomes across five sub-themes.

- Sustainable communities and transport
- Safer and stronger communities
- Healthier communities
- Older people
- Children and young people

You are strongly advised to keep track of the evolving CAA framework by talking to colleagues, especially those in the Local Authority Chief Executive’s office and by getting anorak-y and by looking at the Audit Commission website www.audit-commission.gov.uk Local Health Plans

PCT’s build up Local Delivery Plans (LDP) which lay out spend and strategic intentions for healthcare for their local area. These sit alongside any additional local plans based on analysis of local health needs. You may hear a lot of mention of PCT targets. In terms of drugs, this means the drugs targets in Vital Signs – which are the same as those in the Local Indicator Set.

These plans are brought together by the Strategic Health Authority (which may comprise 7 or 8 PCT areas) into a single SHA plan for the Department of Health.

Other than Level Two Vital Signs targets, arrangements for performance management and delivery are a matter for local determination.

These should be set and monitored by the PCT in their role as a member of either the DAT or the CDRP and of course the LSP – which for PCTs, just like the rest of us, is the only game in town.

However well integrated your local authority and PCT there are still some health specific changes taking place that may impact on your local health partners:

**Our NHS Our Future** – Lord Darzi’s initial report of his review of the NHS on its 60th birthday proposed transformational system wide reform of health care. Lord Darzi called for a greater emphasis on services being orientated toward the experience of the patients. To do this will require a much greater integration of primary and secondary healthcare closer to the community. Darzi also challenges PCTs to transform (that word again) their commissioning into...

**World Class Commissioning** – If you haven’t heard of it yet you will do soon. World Class Commissioning requires PCTs and their partners to create structures for services that are strategic, focussed on outcomes and committed to community wide health improvement. What this means is that commissioning will need, like all of us, to be focussed on local intelligence, engaging with the community, working with partners and meeting local need. Central direction will be focussed on top line strategy. So where does this leave us?

In short – at the moment its probably fair to describe DATs and local partnerships working around drugs as accountable for everything but at the centre of nothing.

The multiplicity of specialist plans required of some DATs by central government bodies is daunting. But that’s as much a feature of the change in strategy and the driving force of the localism agenda after a period of real hard line central control. Its not a situation that will or should last – though its probably only local partnerships themselves who can shift the ground. We need to see what the impact of the National Audit Office and Cabinet Office work on delivery mechanisms turns out to be.

Whatever the confusion in terms of monitoring and development, there are a number of clear messages to DATs.

Your ambitions need to be about more than just treatment. Treatment is important, but given the localism agenda you need to be really getting your hands dirty with enforcement, education, community engagement and reintegration.

You need a stronger relationship with your LSP. You might do this by shifting local governance structures to ensure that the reporting and accountability line from your DAT goes to the LSP (albeit if necessary through one of its theme groups). The critical thing here of course will be to make sure this isn’t just about having a line on a chart, but about actually reporting to the LSP about what you’re doing and what you’re trying to do.

Show people what treatment can achieve if all the other stuff is happening alongside it. Demonstrate the impact street level policing can have on fear and community anxiety about drugs and drug related crime. If you talk about retention and stuff like that explain why its important. The targets we have don’t mean a lot to many on the LSP – you need to make the DAT agenda meaningful – and human. Use the new definition of recovery if this helps make the case.

Maybe your DATs or other local partnerships need to review their membership. If you don’t have key opinion formers, individuals with decision making power and people who really understand the drugs agenda, need to broaden your reach. Given how reliant you’re going to be over the next few years on your local links, now is time to give them a once over. Some people might see the lack of levers to really deliver on the new strategy as a problem. But actually it gives you a real opportunity to find your own. Instead of spending hours concentrating on national targets and imperatives you can devote time and resources to the issues that impact on your local area and the people who live there.

sara.mcgrail@btinternet.com

david.mackintosh@cityoflondon.gov.uk Useful contacts

Home Office The central source of information from the Drug Strategy Unit. A wealth of information which should be able to help with a wide range of queries, including identifying local contacts. www.drugs.gov.uk/Home

The National Treatment Agency The National Treatment Agency (NTA) is a special health authority, created by the Government in 2001 to help improve the availability, capacity and effectiveness of treatment for drug misuse in England. www.nta.nhs.uk

The London Drug Policy Forum www.cityoflondon.gov.uk/ldpf

For drug information and advice, the government funds FRANK 0800 77 66 00 www.talktofrank.com

For an update on many of the issues raised in this guide and a useful commentary on drug policy development. www.saramcgrail.co.uk Index

A Action Plan 4, 7, 42 Adfam 19 Alcohol Concern 19 Alliance, The 19 Annual Performance Assessment (APA) 45, 46 Area Based Grant (ABG) 9, 34, 37, 40 Area Cost Differential 33 Assessments of Policing and Community Safety (APACS) 9, 21, 37, 38, 39 Association of Chief Police Officers (ACPO) 12

B Basic/Borough Command Unit (BCU) 28, 29 Beast of Bodmin 24

C Cabinet Office 5, 48 Children and Young People’s Plans (CYPP) 45 Children and Young People Substance Misuse Plans 31 Children’s Act 2004, The 45, Children’s Trusts 11, 23, 27, 45, 46 Commission for Social Care Improvement (CSCI) 14, 31 Community Plan. See Sustainable Community Strategy Comprehensive Area Assessment (CAA) 21, 39, 40, 46 Concordat 37 Court Service, The 18 Crime and Disorder Act 1998, The 20 Crime and Disorder Reduction Partnerships (CDRPs) 2, 3, 16, 20-22, 24, 25, 29-31, 36, 47 Crown Prosecution Service (CPS) 18

D Dashboard Reports 32 Demand reduction 4, 22 Department for Children, Schools and Families (DCSF) 2, 3, 10, 11, 13, 16, 42, 43 Department for Communities and Local Government (CLG) 11, 37 Department of Health (DH) 2, 3, 10, 13, 17, 33, 42, 47 Deputy Regional Managers 16 Drug Action Teams (DATs) 1-6, 14, 16, 21-25, 27, 28, 30-32, 34, 36, 40-43, 47, 48 Drug Intervention Programme (DIP) 8, 10, 13, 18, 23, 30, 32, 34, 38 Drugs - Protecting Communities and Families 2 DrugScope 19 Drugs Intervention Record (DIR) 32 Drugs Public Service Agreements 9 Drug Strategy Unit 13, 50

E Employment 6, 8, 30, 36, 39, 40, 42, European Association for the Treatment of Addiction (EATA) 19 Every Child Matters 45, 46

F Face the People 21, 44 FRANK 50

G Government Offices for the Regions (GORs) 2, 3, 13, 15-17, 37

H Hallmarks of Effective Partnership 20 Harm reduction 4, 11, 22, 28 Healthcare Commission (HCC) 13, 14, 27, 31 HM Revenue and Customs (HMRC) 12 Home Office (HO) 2, 3, 10, 13, 16, 21, 23, 32, 34 Housing 6, 19, 23, 24, 27, 30, 36, 37, 39, 40, 44 I Integrated Drug Treatment System 22, 23, 31

J Joint Area Review (JAR) 45, 46 Joint Commissioning Groups (JCGs) 22, 24, 25, 30 Joint Commissioning Manager (JCM) 1, 22, 25

K Key Lines of Enquiry (KLOE) 46

L Local Area Agreement (LAA) 1, 9, 11, 16, 37, 40, 41 Local Authorities 1-3, 18, 20-22, 25, 27, 28, 31, 33-35, 37 41, 45-47 Local Criminal Justice Boards (LCJBs) 18 Local Government Association (LGA) 9, 37 Local Indicators 9, 21, 38 Local Strategic Partnerships (LSPs) 1, 2, 11, 17, 20, 24, 35-37, 40, 41, 44, 47, 48 London Drug Policy Forum (LDPF) 50

M Mainstreaming 5, 6, 20, 23, 32 Ministry of Justice (MoJ) 2, 3, 10, 13, 18 Models of Care (MoC) 25

N Narcotics Anonymous 19 National Drug Treatment Monitoring System (NDTMS) 17, 32 National Intelligence Model (NIM) 29 National Offender Management Service (NOMS) 10, 13, 16, 18 National Probation Service 18 National Treatment Agency for Substance Misuse (NTA) 2, 6, 8, 10, 11, 13, 14, 16, 24, 30-33, 38, 50 Needs Assessment 26, 30, 31, 37, 44, 45, NOMS Regional Offender Managers (NOMROMs) 10, 13, 16, NOMS Regional Offices 16

O Office for Standards in Education (Ofsted) 8, 27

P Personalisation 5, 14, 32 Planning Grids, The. See Treatment Plan 30 Police Authorities 12, 18, 29 Police Reform Act 2002, The 20 Pooled Treatment Budget (PTB) 8, 17, 22, 25, 30, 32, 33, 38 Primary Care Trusts (PCTs) 3, 10, 17, 21, 22, 23, 25, 30, 31, 41, 45, 47 Prison 10, 16, 18, 22, 23, 27, 31 Public Health Observatories (PHOs) 17 Public Service Agreements (PSAs) 2, 7-11, 21, 38, 39, 40, 42, 43

R Recovery 6, 10, 19, 40, 48 Regional Agencies 15 S Safer Neighbourhood Teams (SNTs) 29 Self-Assessment Checklist 30 Serious Organised Crime Agency (SOCA) 12 Spending Review 7 Spot 35 Strategic Health Authorities (SHAs) 3, 10, 13, 17, 47 Strategic Summary, The. See Treatment Plan Supply reduction 4, 5 Supply side interventions 5, 22, 24 Sustainable Community Strategy 35, 37

T Tackling Drug Misuse 2 Treatment 17, 21-25, 28, 30-33, 37-40, 42-44, 48 Treatment in prisons 23 Treatment Outcome Profile (TOPs) 32, 42 Treatment Plan 30, 31

U United Kingdom Drug Policy Commission (UKDPC) 19

V Vital Signs 9, 10, 21, 30, 37-39, 47

W Working Neighbourhoods Fund 40

Y Youth Offender Institution (YOI) 22 York Formula 33 Youth Justice Board (YJB) 14, 16, 27 Youth Offending Teams (YOTs) 14, 16, 18, 27, 31, 45 ‘Local areas will have greater autonomy and flexibility to respond to the local needs and to the priorities of local communities, and this flexibility will underpin our new approach’

Drugs: Protecting Families and Communities 2008